Health Watch: Reform School

Have you missed out on health insurance because you happened to list an injury you got in gymnastics class when you were seven, even though it’s never required treatment? Ever gambled while you were shopping for an individual plan, wondering whether you should splurge on maternity coverage even though you weren’t planning to get pregnant? Or perhaps you had consistent coverage through your employer, but you put off that recommended mammogram because of the required copay?

Under the Affordable Care Act, passed by Congress in March 2010 and largely upheld by the US Supreme Court in a decision announced in June, such experiences may fade into tall-tale nostalgia—like your grandmother having to walk five miles through the snow to school, uphill, both ways.

According to Dr. Michelle Berlin, an ob-gyn and the associate director of the Center for Women’s Health at Oregon Health & Science University, “the legislation as it now stands is poised to have a profoundly positive impact on the health of women at every stage of life.” For starters, she says, more than 13.5 million American women will gain coverage under the act, which requires that most people carry insurance or pay a penalty, based on a percentage of income. But most of the requirements fall on insurance companies and states that will set up insurance exchanges; the plans they offer must meet certain criteria.

As the new regulations continue to take effect, Dr. Berlin says, women will notice that many aspects of their health care just got easier. Starting this year, for example, most new plans must cover recommended preventive services like mammograms and Pap smears with no out-of-pocket costs (like a copay or a deductible). This requirement also applies to contraceptive care and lactation services.

Beginning in 2014, insurers may not limit coverage for a “preexisting condition,” a term that the National Women’s Law Center points out has been applied not only to having diseases like cancer and diabetes, but also to having once needed a C-section or being a survivor of domestic violence. Also as of 2014, people cannot be charged more for insurance plans just because they happen to have a uterus, and all plans will have to include maternity coverage. As Speaker Nancy Pelosi said in the House debate on the act, its passage would mean that “being a woman is no longer a preexisting medical condition.”

Of course, the Affordable Care Act may still be altered by Congress, and its implementation could change after this fall’s presidential election. But even without the aid of “a proverbial crystal ball,” as Dr. Berlin puts it, women can take comfort in the act’s promise of a new commitment to care.